Originally published in The Ottawa Citizen October 29, 2002
Original Title: Child Projectiles

One area of a family doctor’s job is to prevent disease and injury. A good starting point is during the annual exam. A comprehensive exam asks the patient about their diet, family history of disease, smoking, alcohol intake, drug use and work environment. One question causes many of my patients to respond with querying confused look: Do you use your seatbelt?

Most will answer that they indeed do. The follow-up question is how do you attach your seatbelt? I ask them to demonstrate what they do to secure it. Not one person in the 12 years of asking this question has demonstrated the correct technique. Not one.

Most will indicate that they pull the belt over their shoulder and attach it into the locking clasp leaving the lap portion of the belt to lie wherever it lands. Although this configuration will help reduce head and upper torso injuries, the lap belt, if not positioned properly, will push into the abdomen with the potential to cause bladder, uterine (if pregnant) and intestinal rupture in moderate to high speed frontal collisions. Emptying the bladder before driving with regular pit stops can prevent its rupture on impact.

The correct lap belt position is below the bump on the front of your pelvic (hip) bone. A natural notch below the bump locks the belt in place preventing serious injury. Pull the belt taut into this notch.

It would make an interesting study to determine how many adults use the correct technique. I would hedge my bet and say that at least 80 to 90 percent of adults do not properly secure their belts.

Many patients coming for their first major check-up are in their teens, 20’s or 30’s. The reason for the seatbelt question is that their risk of injury and death from car accidents exceeds many common diseases.

Traffic injuries are the leading cause of injury related deaths for children and adolescents (46.8%). The majority of these deaths (69.3%) occur when the child is a passenger.

The 1999 statistics for children aged 12 or under show there were 80 deaths and more than 9,000 injuries; among children under five years of age, 34 deaths and more than 3,600 injuries.

Given the above, how well are children secured in their car seats and boosters? A 1997 Transport Canada’s report of child restraint use surveyed 206 sites nationwide involving 22,037 observations of children under 16 years old. Of the 87 percent of children using restraints or seatbelts, only 67% were properly secured.

The survey further states, “only 40 percent of three and four year olds were observed in child seats, and 31 percent were restrained with a seat belt. Five to nine year-olds had the highest percentage of unrestrained children at 15.4 percent. Thirty percent of the rear-facing infant seats were used incorrectly in the forward position. Thirty-three percent of forward-facing child seats did not have the required tether strap attached to the vehicles.”

Factors contributing to the misuse of car seats include:

• Problems installing the restraint system in vehicle,

• Transferring the system from one car/van to another,

• Faulty design,

• Lack of knowledge identifying the child’s stage of development,

• Accessibility of car safety seats for large families.

Parents often ask when they can switch from rear-facing to forward-facing child seats. Many use the child’s weight as their yardstick. Using weight alone should not determine when to change the seat position.

Indeed, the physical development of the infant and child is a major determinant in this case. Infants have weak neck and back muscles and some have large heads. Their skulls are soft and pliable. In a frontal collision, their heads would propel forward injuring the spinal cord and brain stem.

Some babies can attain a weight greater the ten kilograms before six months of age. Until they can control their head movements, their seat should remain facing the rear. Although most ten-kilogram infants can be safely transferred to a front facing system, your doctor can help determine the proper time to do so.

Transport Canada’s web site, Car Time 1-2-3-4: Safe Seating in the Kid Zone (http://www.tc.gc.ca/roadsafety/childsafe/cartenv/index-e.html) is an excellent reference for parents. Parents will learn how to install their child’s car seat. The site provides a four-stage process for changing the car seat from birth to 12 years-old. The free video, Car Time 1-2-3-4, shows how to keep children of all ages safer in vehicles — and includes a special segment designed for children 8 to 12 (http://www.tc.gc.ca/roadsafety/childsafe/rscar1234_e.asp).

Take advantage of this site. A small adjustment to your child’s car seat may prevent serious injury and your child from becoming a projectile.